Ayelew Adinew was working as a pharmacist in a large public hospital in Addis Ababa, Ethiopia. He looked around and saw that the 100-year old pharmaceutical system was broken.

There was no transparent and accountable system for providing the information needed for effective monitoring and auditing of pharmaceuticals and other commodities. There was not sufficient documentation to track consumption, inventory discrepancies, wastage, product over-stock or under-stock. There were no procedures to ensure the availability of essential medicines. The regulations were outdated and there was no enforcement of the relevant regulations in place to protect the safety of clients, ensure proper utilization of resources, and deter professional malpractice.

Guaranteeing that patients have uninterrupted access to anti-tuberculosis (TB) treatment begins with national TB programs (NTP) making complex calculations about how many cases to expect in the future. Vigilant stock management, accurate number of cases started on each type of treatment along with forecasting the expected number of patients that will be enrolled on treatment, are vital to ensure that medicines are available to all patients who need them.

Does antimicrobial resistance mean the end of modern medicine as we know it? Not quite yet. However, in a report recently released on global surveillance of antimicrobial resistance (AMR), the World Health Organization (WHO) warned that "a post-antibiotic era–in which common infections and minor injuries can kill–is a very real possibility for the 21st century."

Many countries in Central and South America have made significant progress toward eliminating malaria. Between 2000 and 2012, 13 countries in the Americas saw malaria incidence rates drop by more than 75 percent. Argentina, Belize, Costa Rica, Ecuador, El Salvador, Mexico, and Paraguay have all reached the pre-elimination phase, a designation given by the World Health Organization (WHO) when countries meet certain critical steps in eliminating the disease and preventing its reintroduction.

While this progress is encouraging, efforts to eliminate and control other global threats like polio illustrate that the last cases are often the most difficult to address. In the case of malaria, fewer cases bring new challenges in ensuring the supply and proper management of antimalarial medicines.

Representatives from 13 MSH countries—Afghanistan, Angola, Cote d’Ivoire, DRC, Ethiopia, Ghana, Haiti, Kenya, Nigeria, Rwanda, South Africa, Tanzania, and Uganda—shared stories and materials about the lives saved and health impact of MSH’s work, in partnership with US Agency for International Development (USAID) and others, at the MSH Country Health Impact Fair at the Ronald Reagan Building in Washington, DC, last week. Country ownership and health impact were common themes at the fair.

Successfully combating the tuberculosis (TB) epidemic requires that national TB programs (NTPs) prevent new infections and ensure that current patients are cured. Although the treatment for drug-sensitive TB is very effective, curing the disease requires that patients adhere to a strict daily regimen of multiple pills for six to nine months. Adding to the challenge is the fact that treatment for drug-resistant TB is longer, more toxic, and less effective.

All medicines carry some risk of adverse events, and anti-TB medicines are no exception. In addition to threatening the health of patients, adverse events, if not well managed, may also result in individuals stopping their treatment early. Patients who prematurely discontinue treatment may remain sick, develop resistance to the medicines, and spread TB to others in their community.

Safe and rational use of these medicines is also a challenge. To deal with these demanding challenges means an increased need to strengthen pharmaceutical management, especially in the areas of second-line TB medicines management, new TB medicines, and novel treatment regimens.

Azmara Ashenafi, a 35-year-old woman from the Amhara region of Ethiopia, was diagnosed with tuberculosis (TB) and placed on treatment. She was fortunate. Many people with TB are missed by health systems altogether. But Azmara’a treatment wasn’t helping. Despite taking medicine for months, her symptoms persisted and became more severe.

MDR-TB cannot be treated with the two most potent first line anti-TB drugs and infects 6,000 Ethiopians each year. To help curb the spread of the disease, health workers learn how to screen people in close contact with MDR-TB patients. All of Azmara’s family members were tested and both she and her three year old son Feseha were found to have MDR-TB.

SIAPS partnered with the Tanzanian National Tuberculosis and Leprosy Program to train drug dispensers on the symptoms of TB, so that they could refer clients with these symptoms to TB diagnostic and treatment centers for follow up.